Pre-service Education on FP and AYSRH

1. Pre-service Education on FP and AYSRH Session II, Topic 10 Female Sterilization Female Sterilization, Session II Topic 10 Slide 1

2. What is Female Sterilization ? • A safe and simple surgical procedure that provides permanent contraception for women who do not want any more children. • It involves cutting or blocking the two fallopian tubes. • Other names are tubal sterilization, tubal ligation, voluntary surgical contraception, tubectomy, Bi-lateral tubal ligation. • The method is generally irreversible so informed consent is key Female Sterilization, Session II Topic 10 Slide 2

3. What is Female Sterilization (continued) Two surgical approaches most often used: • Minilaparotomy using local anesthesia and light sedation is the approved standard procedure for BTL. A small incision is made on the abdomen and the tubes are brought to the incision to be cut and blocked. • Laparoscopy – a long thin tube with a lens in it is inserted in the abdomen through a small incision; the tubes are visualized, blocked or cut. Female Sterilization, Session II Topic 10 Slide 3

4. Mechanism of Action • The fallopian tubes that carry the eggs from the ovaries are cut off and blocked. • Eggs released from the ovaries cannot move down the fallopian tubes to meet the sperm. • Works because the fallopian tubes are blocked or cut. Eggs released from the ovaries cannot move down the tubes, and so they do not meet sperm. Female Sterilization, Session II Topic 10 Slide 4

5. Diagram Showing the Female Reproductive Organs Female Sterilization, Session II Topic 10 Slide 5

6. Effectiveness of Female Sterilization • Female sterilization is one of the most effective methods of contraception but carries a small risk of failure. • It is 99.5% effective, which means that the failure rate of the method is 5 pregnancies per 1,000 during the first year following the surgery • Varies slightly depending on how the tubes are blocked, but pregnancy rates are still low with all techniques. • One of the most effective methods is cutting and tying the ends of the fallopian tubes after childbirth. Female Sterilization, Session II Topic 10 Slide 6

7. Effectiveness of Female Sterilization In this progression of effectiveness, you can see that female sterilization is very effective. More effective Less effective Female Sterilization, Session II Topic 10 Slide 7

8. Advantages of Female Sterilization • Permanent method of contraception which protects against risk pregnancies • Nothing to remember, no supplies needed, and no repeated clinic visits required • Does not interfere with sex • Does not affect a woman’s ability to have sex • Results in increased sexual enjoyment - no need to worry about pregnancy • No effect on breastfeeding • No known long-term side effects or health risks • Can be performed immediately after delivery • Is effective immediately Female Sterilization, Session II Topic 10 Slide 8

9. Disadvantages of Female Sterilization • Requires minor surgery by a specially trained physician • Requires an operating room set-up • Considered to be permanent • Does not protect against STIs and HIV if at risk of HIV or STI he couple has to use condoms as well. • Limitation of physical activities for about one week Related to surgical procedure: • May have pain and swelling over the operative site (diminishes in a day or two) • Superficial bleeding Female Sterilization, Session II Topic 10 Slide 9

10. When You Can Have Sterilization ? Most women can have sterilization at any time But may need to wait if: • Some other serious health conditions • Gave birth between 1 and 6 weeks ago • May be pregnant • Infection or other problem in female organs Female Sterilization, Session II Topic 10 Slide 10 Source: WHO decision making tool for FP2005

11. Time for Performing Female Sterilization Postpartum • Immediately or within seven days after giving birth Interval • From six weeks after childbirth if it is reasonably certain that the woman is not pregnant (see handout for screening to check if client is not pregnant) • Within seven days after the start of the woman’s menstrual cycle • At any time if it is reasonably certain that the woman is not pregnant Female Sterilization, Session II Topic 10 Slide 11

12. Time for Performing Female Sterilization (continued) • During caesarian section • If switching from oral contraceptives, she can continue taking the pills until she has finished that pack • After using emergency pill - within 7 days after she starts her menstrual periods • Post abortion: Within 48 hours after uncomplicated abortion. Female Sterilization, Session II Topic 10 Slide 12

13. Who Can Have Female Sterilization • All women can have female sterilization. Including women who; • Have no children or few children • Are not married • Do not have husbands permission • Are young • Just give birth within the last 7 days • Are breast feeding • Are infected with HIV whether or not on ARVs • No medical conditions prevent a woman from using female sterilization. Female Sterilization, Session II Topic 10 Slide 13

14. Who Can Have Female Sterilization(continued) In the checklist (hand out): Caution means the procedure can be performed in a routine setting but with extra preparation and precautions, depending on the condition. • Delay means postpone female sterilization. These conditions must be treated and resolved before female sterilization can be performed. Give the client another method to use until the procedure can be performed. Female Sterilization, Session II Topic 10 Slide 14

15. Who Can Have Female Sterilization(continued) • Special means special arrangements should be made to perform the procedure in a setting with an experienced surgeon and staff, equipment to provide general anesthesia, and other backup medical support. • For these conditions, the capacity to decide on the most appropriate procedure and anesthesia regimen also is needed. Give the client another method to use until the procedure can be performed. Female Sterilization, Session II Topic 10 Slide 15

16. “Come Back Any Time” Reasons to Return In first week, come at once if: • Pus or bleeding from wound • High fever • Pain, heat, swelling, redness of wound • Fainting or very dizzy • Steady or worsening pain, cramps, tenderness in belly At any time in the future, come at once if: • You think you may be pregnant • Pain or tenderness in belly, or fainting Female Sterilization, Session II Topic 10 Slide 16 Source: WHO Decision Making Tool for FP for Clients and Providers 2005

17. Counseling Process: Client has Selected Female Sterilization • Key counseling points to check for before procedure of referral for procedure: • That client understands that: • This is a permanent method • There are other options that they can use that are just as effective like Implants and IUDs. • She will have the surgery under local and might experience some pain after the procedure for first few days. Method does not protect against HIV and STDs she will have to use condoms of at risk Female Sterilization, Session II Topic 10 Slide 17

18. Counseling a Client for Female Sterilization • Determine that the woman is not pregnant. • Assess client’s reproductive needs, risks for STIs, status of relationship with partner, and knowledge on FP method. • Use the FP Service record cards (or any approved assessment form) as a tool for undertaking assessment. • Use appropriate types of questions (i.e., closed, open-ended, probing) during assessment of the client. Female Sterilization, Session II Topic 10 Slide 18

19. Counseling a Client for Female Sterilization (continued) • Describe available family planning (FP) methods based on client’s reproductive need. • Discuss BTL as a FP method in terms of: Definition, Mechanism of action., Effectiveness, Advantages and Disadvantages, Possible side effects • Correct rumors and misconceptions. • Identify the reasons for clients’ return visits. Female Sterilization, Session II Topic 10 Slide 19

20. Counseling a Client for Female Sterilization (continued) • Ensure informed choice and consent form signed – clients must understand the following:- that temporary methods are also available, voluntary sterilization is a surgical procedure, there are certain risks of the procedure as well as benefits, if successful is permanent, client can decide against the procedure at any Female Sterilization, Session II Topic 10 Slide 20

21. Summary • A woman considering sterilization should think carefully: “Could I want more children in the future?” Health care providers can help the client think about this question and make an informed choice. If the answer is “Yes, I could want more children,” another family planning method would be a better choice. Female Sterilization, Session II Topic 10 Slide 21